The Specific Aim (Purpose) of this Research and Demonstration Project is to create a model of Hospital:Long Term Care Facility (LTCF) infection control collaboration by developing LTCF- tailored interventions that reduce infection risk in the elderly; and to use the prevention of methicillin-resistant Staphylococcus aureus (MRSA) disease as the program proof-of-concept model. Over the last 15 years, the medical community has become concerned about the rise of the drug-resistant form of staph called MRSA, which causes particularly dangerous disease. Our hypothesis is that one can safely reduce MRSA colonization and disease from LTCF residents in a way that does not interfere with the desired life-style for persons in these facilities and thereby lower the cost of care by preventing illness. While a great deal of medical research and public advocacy has focused on the control of MRSA spread in acute care centers, little attention has been paid to LTCFs. On August 1, 2005, NorthShore University HealthSystem became the first multi-hospital healthcare system in North America to adopt universal admission surveillance for MRSA. In the 48 months following program implementation, the rate of MRSA in the acute care hospitals dropped by more than 70% compared to the past. When assessing the likely burden of MRSA disease in 3 LTCFs, we found that the rate of treated illness ranged from 12 to 114 annual infections per 100 beds in the facility (median 37 infections/100 beds) across the 9 units for which we collected data - strongly indicating that not only is colonization frequent in LTCFs but that the burden of MRSA disease is also high. Pilot programs at 3 LTCFs have permitted us to design a theoretical program to reduce MRSA colonization and disease in a way that respects the necessary living requirements for residents of LTCFs. The external funding requested will permit us to evaluate those interventions we have discovered as theoretically effective. The activities will entail an IRB-approved, cluster randomized trial on 12 nursing units (approximately 650 beds in total) at three different LTCF that have a total of approximately 4200 annual admissions. These 12 units will be randomly assigned to a specific intervention (decolonization of all current residents plus admission testing and nasal treatment of new patients) or control. The study duration is 24 months; a stop period at 12 months is planned when a scheduled preliminary analysis will be done. At the time of this 12-month analysis it will be decided if the project was successful and the intervention arm will be deployed on all nursing units. Subsequently, additional LTCF partners in the Chicago area will be offered assistance in implementation of similar programs. At least 2 publications are planned.